Justin and Yvonne are Physical Therapy students at the University of Toronto. They hope to help people recover by sharing their knowledge with the Curovate community.

If you have already read part 1 and part 2 of our jumper's knee blog posts now we will show you how you can treat and solve the problem of jumpers knee at home! Watch the video to find out how to do these simple exercises and how often and how many to do every day.

What is Patellar Tendinopathy?
The patella, also known as the kneecap, is connected to the lower leg by a stringy structure called the patella tendon.
Jumper's knee, also known as patellar tendinopathy, is an injury where the patellar tendon gets overworked due to too much stress over time.1 The patellar tendon is put under a lot of stress when jumping, landing, starting, and stopping. When these activities are done too often with a lot of force, the patellar tendon begins to change its structure in a way that causes pain.1 If you want to read more about jumpers knee refer to our previous blog here.

Evidence For Decline Squats
Many studies have shown that lowering yourself down during a squat (called an eccentric movement) on a decline surface is effective for treating patellar tendinopathy. This is likely because for the same amount of work, there is more loading on the patellar tendon, compared to the thigh muscles, when in the decline position2. As long as the decline squat is completed in a controlled manner and not over-done, loading the tendon improves its function.3

Regular Squats vs Decline Squats: One study that looked at regular squats vs. decline squats in 17 patients found that decline squat training caused less pain and lead to a faster return to full function in daily life compared to regular squats.4

One-legged Decline Squats vs One-legged Step Squats: A one-legged step squat is where the back leg is elevated on a step and the front leg is lowering the body. A study completed on 17 volleyball players found that one-legged decline squats were more effective than one-legged step squats for improving pain and the players score on a knee function test after 12 months.5

Horizontal Surface vs Decline Surface: One study completed on 13 people showed that eccentric squats on a decline board worked the patellar tendon 20-25% more than eccentric squats on a flat surface.6 This demonstrates that a decline surface is better at strengthening the patellar tendon.

Protocol For Decline Squat Program or how many and how often should I do decline squats:
One study that researched the best guidelines for treating patellar tendionpathy found that decline squats must be included in the program to help patellar tendinopathy.3 The researchers suggested decline squats should be done twice a day for 3 sets of 15 repetitions based on the results they gathered from 7 other research papers.3 The article found that adding resistance slowly over time helps improve the patellar tendon's function as long as the exercise is done with control, and not done excessively.3

Our next blog post will be a video on how exactly to do decline squats at home with instructions on how to progress.

There are many factors that contribute to how a person will recover after ACL surgery. The 4 major factors for recovery are listed below. The first 2 are things you can control or work on to improve your recovery. The last 2 are factors that you do not have control over.

1. Ability to bend the knee fully before surgery
A study that looked at factors affecting recovery after ACL surgery found that people who were able to bend their knee all the way before surgery had faster recoveries than those who could not bend their knee all the way.1 Fortunately, physiotherapy treatment can help improve your ability to bend your knee before and after surgery. Our app Curovate can also help your ability to bend your knee.

2. Strength of muscles around the knee
The strength of the muscles that move the knee can predict how long it will take to recover. The faster the injured knee regains strength equal to the unaffected knee after surgery, the better the outcome is 1 year later.2 It is especially important to regain strength in the hamstring muscles (at the back of the thigh that help bend the knee). Weak hamstring muscles increases the risk of re-injuring the ACL.3 The exercises in our app Curovate can help you regain your strength.

3. Age
You may have heard before that young people heal much faster than older people. This happens to be the case when it comes to ACL surgery and getting back to all of your activities. Surgery is sometimes avoided in older people because of a higher complication rate compared to younger people.4 A study on 104 patients that underwent ACL surgery found that 12 months after ACL surgery, patients who were 20 years old or younger needed less rehabilitation time than patients over 20 years old. The younger patients had less pain, less swelling, better mobility, and strength and returned back to their normal level faster.5

4. Other injured structures in the knee
There are 4 major ligaments that stabilize the knee: ACL, PCL, MCL, and LCL. The ACL can be injured alone but in more severe injuries, other structures can be torn as well. One study showed the patients who had torn multiple ligaments had a longer recovery time compared to just tearing their ACL alone.5 This is because multiple ligament injuries might require more procedures, have more pain and symptoms, and also require more time before the patient can move after surgery.5

Other common factors that have been studied with regards to how a person will recover from ACL surgery include gender, body mass index (BMI - a ratio of height to weight), and type of ACL graft used. These factors do not have a strong influence on the rate of recovery.6